Active Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) or bring it with you to your appointment.

Please fill out ONE of the following forms based on your condition. If you have any questions on which form applies please contact us by email (Click Here) or phone 6836 0833 Orchard branch , 6258 6160 Toa Payoh branch

New Patient Application Forms - Required

This lets us know the history and current state of your health and if you are a current candidate for our care.

Decompression Treatment Application Form

Neuropathy Treatment Application Form

Intake Adult - English

Intake Adult - Mandarin

Intake Child - English/Mandarin

Treatment - Required

Download & Print Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!